title: Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later.
abstract: OBJECTIVE
  Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered.
  
  
  METHODS
  SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a 6-month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.
  
  
  RESULTS
  Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6-month follow-up (4 of 6 sites), were 67.7% lower (p<0.001) and heavy alcohol use was 38.6% lower (p<0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p<0.001), mental health (p<0.001), employment (p<0.001), housing status (p<0.001), and criminal behavior (p<0.001) were found.
  
  
  CONCLUSIONS
  SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.
authors.affiliation: Harvard Medical School-NEPRC, 1 Pine Hill Drive, Southborough, MA 01772, USA. bertha_madras@hms.harvard.edu
authors.forename: Bertha K
authors.initials: BK
authors.lastname: Madras
authors.forename: Wilson M
authors.initials: WM
authors.lastname: Compton
authors.forename: Deepa
authors.initials: D
authors.lastname: Avula
authors.forename: Tom
authors.initials: T
authors.lastname: Stegbauer
authors.forename: Jack B
authors.initials: JB
authors.lastname: Stein
authors.forename: H Westley
authors.initials: HW
authors.lastname: Clark
mesh_terms: D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D003151:Community Health Centers; D003415:Crime / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D004651:Employment / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D012424:Rural Population; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D014193:Trauma Centers; D016896:Treatment Outcome; D014505:Urban Population; D055815:Young Adult
chemical_list: D013287:Illicit Drugs